Use of the diagnosis of Parental Alienation Syndrome (PAS) in family law cases has generated substantial debate. When one parent alleges the other is alienating a child or committing a similar wrongdoing, it is incumbent upon the attorneys within the adversarial process to explore and challenge the factual basis of both positions. In cases involving PAS, not only is the diagnosis of PAS questioned in predictable ways in the courtroom, the critique often extends on a more personal level to the syndrome's originator, Richard Gardner, M.D.(1) Much of the literature often considered by courts as authoritative in challenging Gardner or PAS is based on opinion rather than fact.

Recently published articles contain criticisms and even misconceptions of PAS, and in some cases are critical of Gardner himself. To sort through the misconceptions, they have been extracted from various sources and cataloged below. Following each "myth" is a counter argument that places each criticism in context.

Myth #1: PAS is not in the DSMIV and therefore does not exist. The DSM-IV is the diagnostic manual for all mental health providers. It is re-written every 10 to 12 years, and is the collaborative result of committees of mental health professionals reviewing the most recent scientific literature on all psychiatric disorders. The committees make recommendations on modifications of symptom lists for the diagnosis of a disorder, consider the inclusion of newly identified disorders, and in some cases remove disorders from classification.

The argument is that since PAS is not in the DSM-Iv, it does not exist. The DSM-IV, was published in 1994, with its committees first meeting from 1991 to 1993.(2) The first publication on PAS appeared in 1987.(3) At By J. Michael Bone, Ph.D., Winter Park that time there were understandably too few published articles and research studies on PAS to warrant its inclusion into the DSM-Iv. It is also important to note that inclusion into the DSM is necessarily a very conservative and stringent process, requiring many years of study and publication in peer-reviewed journals. Research on PAS was still in its infancy at the time of the DSM-IV, and was never even submitted for consideration. Currently, there are in excess of 135 peer-reviewed published articles on PAS from over 150 authors, as well as numerous books either devoted to PAS or including it.

The committees for the DSM-V have only recently begun meeting, and a PAS file has been opened. It is likely that PAS will be included in the DSM-v. However, even if it is not included, this does not necessarily mean it is invalid. Gille de la Tourette first described the syndrome that bears his name in 1885, but it was not until 1980 that the disorder was included in the DSM. Similarly, the AIDS virus was not in diagnostic manuals when it was first discovered, but its omission did not invalidate its existence. Post-Traumatic Stress Disorder (PTSD) was hotly debated when first described around the end of the war in Viet Nam, and at first was not considered a "real disorder." Currently, PTSD is accepted by all in the profession, and no longer subject to such debate. Other examples abound.

Inclusion in the DSM is ideal but not necessary for a disorder to be considered a reality. Inclusion into the DSM is a process that should and does take time. All newly described disorders begin by not being included; this is simply how the growth of scientific knowledge occurs. To argue, as in the case of litigation, that non-inclusion in the DSM-IV de facto invalidates PAS is a misstatement and a distortion of this scientific process.

Myth #2: Only mothers are guilty of being PAS indoctrinators When the first publications on PAS began to appear in the late 1980's, it was true that most indoctrinating parents were mothers. It is noteworthy that it was just in the prior decade that the "best interest of the child presumption" replaced the "tender years doctrine," making it more possible for mothers to lose custody of their children in divorce. Under the "tender years" doctrine, a mother's losing custody was highly unlikely except in the case of serious abuse. Under the "best interest" presumption, mothers faced a new vulnerability. In response to this, it is likely that one parent indoctrinating the child against the other parent in the context of divorce proved to be a powerful strategy in winning custody. As more time has passed under the guidance of the "best interest" presumption, we are beginning to see more alienating fathers.(4) When these facts are ignored, the argument can be made that PAS is somehow biased against women. This issue has been addressed directly in Gardner's writings; (5) however, critics of PAS continue to maintain that gender bias was and continues to be the case. This criticism misstates the argument and appears to "cherry pick" the literature to advocate a certain position. While it may be considered appropriate for advocates to emphasize certain points and de-emphasize other points in their zeal to protect their client's interests, this advocacy position is highly improper for mental health professionals, who are ethically bound to the pursuit of impartial truth.

Myth #3: PAS is not a syndrome A syndrome is simply a cluster of symptoms with a common etiology. The eight symptoms of PAS are the specific symptoms found in a child who has been successfully alienated. The more symptoms one sees of the eight, as well as the intensity of them, determines the level of severity of the PAS disorder.

The eight symptoms are: (1) A campaign of denigration; (2) weak, frivolous, and absurd rationalizations for the deprecation; (3) lack of ambivalence in the child; (4) the "independent thinker" phenomenon; (5) reflexive support of the alienating parent in the parental conflict; (6) absence of guilt over cruelty to and! or exploitation of the alienated parent; (7) presence of borrowed scenarios; (8) spread of animosity to the extended family of the alienated parent.

In mild PAS, the eight symptoms are mostly present with the exception of two symptoms, which are: lack of ambivalence and absence of guilt over cruelty to the alienated parent.

As one moves from mild to moderate PAS, the remaining six symptoms increase in their severity, and the two symptoms noted above begin to appear. In severe PAS, all the symptoms have progressed to the severe level including the two noted above. In other words, with severe PAS, the child loses his or her ability to empathize and to feel guilt in a patterned and predictable way. This level of symptom organization is the very hallmark of the existence of a syndrome.

Myth #4: PAS is not accepted within the professional community It is often argued that PAS is not accepted in the professional community. One will occasionally see this in an article.(6) This argument is not supported by data, however; as noted above, there are currently over 135 articles published in professional journals that accept PAS. These articles either present argument why it does exist, or they assume the acceptance of PAS as a premise and have moved beyond that to explore nuances of the syndrome. To be accurate, PAS has passed the acceptance phase and has moved into the exploration phase. This criticism is therefore out of date and inaccurate.

Additionally, PAS has been argued and accepted in over 70 court cases in the United States. Internationally, PAS has been accepted in Great Britain, Germany, Canada, Israel, and other countries (see list from website). (7) In this country, PAS has been tested by the Fryer standard twice and affirmed in both cases. The first was in Florida in 1999.(8) The second was in Illinois in 2002.(9) In the face of this information, it is indeed difficult to argue that it is not accepted in the professional community. In fact, it is accepted not only by the professional community in this country, but also by the professional community in the countries listed above, as well as their court systems.

Myth #5: There is an absence of empirical research to support PAS The multiple articles and publications devoted to PAS contain such empirical research, otherwise they would never haven accepted for publication. To argue that the existing PAS literature is not based on empirical research is tantamount to saying that the content of all of this published material is simply "made up."

Myth #6: PAS is not accepted by the courts Much of the response to this criticism has already been mentioned. Of special interest are the legal citations from Florida courts, which are listed in the footnotes.(10)

Myth #7: PAS protects genuinely abusive parents This is also a misinformed position and one most often taken by those least familiar with the literature on PAS. It is clearly and repeatedly stressed in the PAS literature that a PAS diagnosis is not warranted when real abuse is present.(11) Therefore, truly abusive parents cannot take refuge behind a diagnosis of PAS.

It is true that some abusive parents may try to allege victimization by the other parent, whom they also allege to be negatively indoctrinating the child. This is a misapplication of PAS. The PAS evaluator must first and foremost determine the veracity of such abuse allegations. In fact, it is primarily within the PAS literature that strategies have been developed to detect truly abusive parents from falsely accused ones.

The PAS evaluator must take painstaking care in his or her evaluation of the alleged abusive parent, and not simply rely on clinical data from the alleged victim. Prior to the scientific contributions of PAS research, abuse evaluations focused primarily on an evaluation of the alleged victim, with only incidental evaluation of the alleged abuser. It is due almost exclusively to the contribution of PAS-related literature that methods of detecting the alleged perpetrator were developed. This is significant, since virtually all of the professional associations directed that such evaluations should not rely only or even primarily on an evaluation of the victim, but must rely heavily on other sources. It is the PAS literature that has provided strategies to do this.

Myth #8: PAS is the only source of alienation of children It is well documented and understood throughout the literature that children can be alienated from a parent by that parent's own poor behavior. For example, we know that physically and sexually abusive parents can alienate their children. It is also true, though, that it requires severe and fairly consistent abuse to alienate a child from a parent. Anyone who has worked with abused children quickly sees how abused children are still very much affectively tied to their abusive parents. This is one of the most difficult problems in treating such families. It is clear, however, that there comes a point when a parent's abuse can cause a child to want to escape or have no contact with that parent.

What is notable about PAS children is their level of repulsion from their targeted parent is grossly inconsistent with the alleged parental behavior that turned the child away. For example, a PAS child will express never wanting to see a parent again because of "their cooking", or because they "talk like a bumpkin", or because they "take them to Disney World too much." This inconsistency is a hallmark diagnostic centerpiece of PAS, but it is through what we know about the effects of real abuse and what it truly takes to alienate a child from a parent that we derive our knowledge of PAS. The knowledge of real abuse is our measuring stick; it is from truly abused children that we learn how much abuse children will often take without becoming alienated from that parent.

Myth #9: All of Gardner's works are self-published and he is a fraud Richard Gardner, M.D. was a professor of medicine at Columbia University's College of Medicine. His curriculum vitae are easily available. He has published multiple books and peer-reviewed publications beyond those published by his own company. Additionally, the American Psychological Association's (APA) official "Guideline for Custody Evaluations" lists three of Gardner's works in its elite list of references for psychologists who do custody evaluations, including Parental Alienation Syndrome: A Guide for Mental Health Professionals. This reading list, which is officially endorsed by the APA, has over thirty references, and Gardner is the only author listed three times. If Gardner's work and reputation were not completely accepted, these listings would not be contained in the APA reference list.

While it is true that Gardner developed his own publishing company, it is not true that he is not otherwise published. While most would agree that Richard Gardner was the most prolific and tireless authority on PAS in the world, he is not the only source on it. Over 70 writers in addition to Gardner authored the list of publications noted above, and Gardner's company has published none of them. The implication of this criticism is that there is something improper, perhaps even fraudulent, about Gardner having his own publishing company, and that this somehow invalidates PAS. As an aside, it is also interesting to note that Sigmund Freud began his own publishing house in the nineteenth century.

Myth #10: PAS is based on the Sex Abuse Legitimacy Scale This criticism appeared in the family law publication, The Florida Family Law Commentator, which should be taken as evidence of this criticism's widespread acceptance. In this article, its author argued that Richard Gardner had published a test called the Sexual Abuse Legitimacy Scale (SALS), which was designed to help identify genuine sexual abusers from the falsely accused. In 1987, Gardner withdrew the SALS from publication. He did so for two reasons. First, he found that its users were scoring it too subjectively, and that the detailed data gathering that was required was sometimes not adequately done. Second, it was a requirement for its use that both the parents and the children be seen by the evaluator, which was sometimes also not being done. Due to these two reasons, Gardner decided to withdraw it himself rather than risk its being misused.(12) The content of the Scales was never invalidated. Gardner's critics, however, argue that PAS is based on the SALS, which they wrongly label as being invalidated. Additionally, the first article on PAS was published in 1985, two years before the SALS was published and then subsequently withdrawn, which further overturns this criticism.(13) Obviously, PAS could not have been based on something that did not yet exist.

Conclusion One intriguing aspect of the continued criticisms of PAS in the face of overwhelming information is their indelibility. All of these criticisms can be shown to be groundless and false, but they tend to somehow be resurrected in the next hearing or the next pleading. It is difficult to explain the tenacity of these falsehoods. A recent publication of the' American Bar Association featured a review of Divorce Poison, an book by psychologist Richard Warshak, Ph.D. The reviewer criticized Warshak for relying on the work of Richard Gardner regarding Parental Alienation Syndrome, stating, "...the PAS doctrine has widely been discounted."(14) As discussed above, this is simply not accurate; it does, however, expose the peculiar nature of dealing with and litigating PAS. There is tremendous misinformation about PAS and its critics seem driven to maintain these inaccuracies in spite of overwhelming evidence to the contrary.

It is perhaps reminiscent of the father who has been falsely accused of sexually abusing his child in the context of a custody dispute. In spite of the fact that this man has been proven to be innocent, his relationship with his children has been indelibly contaminated by the allegation. The psychodynamics of this phenomenon are difficult to ascertain. As for Richard Gardner, it has occurred to me that he may well be the ultimate targeted parent, falsely vilified in the courts and accused of being a danger to those children whom his work has protected.

Endnotes:

1. It is perhaps ironic that this manuscript was begun just months before Richard Gardner's death in May of this year. Dr. Gardner was responsible for first describing Parental Alienation Syndrome. Since its description almost twenty years ago, he has been responsible for creating an awareness and acceptance of this terrible disorder in children. Since PAS occurs in the divorce context, he suffered many unfair and manufactured criticisms, and in many respects became himself the quintessential and symbolic "target parent" for those indoctrinating parents that his discoveries and work confronted. In spite of this, he maintained a tireless focus on his work, and even a sense of humor. He continued to make contributions to the field until the day of his death, and his tenacity was a lesson to anyone who knew him. His passing is a great loss to us all, and his friendship is missed deeply by those of us who were fortunate enough to know and to work with him. That said, his death might also serve as impetus to us all to continue on in developing remedies for PAS children and families. We are seeing now that PAS can be treated. We are seeing that with the proper interventions, even severely alienated children can be united with both of their parents. These interventions, however, require the conviction and courage that Dr. Gardner casually exemplified every day in his work. 2. Diagnostic and Statistical Manual of Mental Disorders. DSM-IY, American Psychiatric Association (1994). 3. Gardner, RA., The Parental Alienation Syndrome and the Differentiation Between False and Genuine Sex Abuse. Creeskill, N.J., Creative Therapeutics, Inc. (1987) 4. Gardner has recently observed that the current ratio of mothers vs. fathers as alienators are about 50/50. Personal communication. 5. Gardner, RA., The Parental Alienation Syndrome: A Guide for Mental Health Professionals. Creeskill, N.J.: Creative Therapeutics, Inc. See Chapter Five, Subsection entitled, "The Underlying Psychodynamics of the Alienating Father" pp. 188-194 (1992). 6. Ackerman, M., "Does Parental Alienation Syndrome Really Exist?", 2000 Wiley Family Law Update, 145-165 (2000). In this work, Ackerman relies heavily on an article published by Kathleen Faller in which she grossly distorts issues related to PAS. Gardner's rebuttal to it was published before Ackerman wrote this chapter, but was purposefully ignored by him. See Gardner, R "Rebuttal to Kathleen Faller's Article,"Child Maltreatment, 3(4): 309-312 (1998). 7. Multiple of legal cases on international scene 8. Kilgore v. Boyd, 783 So.2nd 257 (Fla. 3d DCA 2000). 9. Bates v. Bates, 18th Judicial Circuit, Dupage County, IL. Case No. 99D958, January 17, 2002. 10. The legal citations in Florida are as follows: . Blosser v. Blosser, 707 So. 2d 718 (Fla. 2d DCA 1998). . Schutz v. Schutz, 522 So. 2d 874 (Fla. 3d DCA 1988). . Tucker v. Greenberg, 674 So. 2d 807 (Fla. 5th DCA 1996). . Berg-Perlow v. Perlow, 816 So.2d 210. . Loten v. Ryan, 15th Circuit Ct, Palm Bch County, Case No. CD 93-6567 FA, 12/11/00 . Kilgore v. Boyd, (Fla 2d DCA 2002) 733 So 2d 546 This case was the first FRYE test for PAS . Boyd v. Kilgore, 773 So. 2nd 546 (Fla. 3d DCA 2000), prohibition den. . McDonald v. McDonald, 9th Circuit, Orange County, FL. Case No. D-R90-11079, 2/ 20/01 . Blackshear v. Blackshear, Hillsborough County, FL, 13th Circuit. 95-08436 11. Gardner, R, "Differentiating between the Parental Alienation Syndrome and bona fide Abuse/Neglect," The American Journal of Family Therapy, 27(2), p. 97-107 (1999). 12. Personal communication. 13. Gardner, R A., "Gardner's Rebuttal to Carol S. Bruch's Article "Parental Alienation Syndrome and Parental Alienation: Getting It Wrong in Child custody Cases," Family Law Quarterly, 35(3): 527-552 (2001). 14. American Psychological Association: Guidelines for Child Custody Evaluations in Divorce Proceedings, American Psychologist, 49(7): p. 677-680 (1994).

J. Michael Bone, Ph.D., is a psychotherapist with a solo practice in Winter Park, Florida. He specializes in high conflict divorce, with a special interest in Parental Alienation Syndrome (PAS). Dr. Bone has conducted .continuing education seminars for psychologists on PAS in multiple states, and worked directly with the late Richard Gardner, M.D. on many occasions. He has authored multiple publications on PAS, and served on the Scientific and Professional Advisory Board of the Parental Alienation Research Foundation in Washington D.c. Dr. Bone has also served as expert witness on PAS in Florida as well as in other states, and has been appointed by the court to make recommendations involving PAS and families.